| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GALLAGHER BENEFIT SERVICES, INC.3 | 116 HUNTINGTON AVENUE, 10TH FLOOR BOSTON, MA 02116 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $8K | -$1K | $7K | 1.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFITS SERVICES, INC. | TWO PIERCE PLACE, 14TH FLOOR ITASCA, IL 60143 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $4K | $4K | 0.65% |
| AGIS NETWORK INC3 Filed as: AGIS NETWORK, INC. | 2122 KRATKY ROAD SAINT LOUIS, MO 63114 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $391 | $4K | 0.61% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 116 HUNTINGTON AVENUE BOSTON, MA 02116 | ESI GROUP | $2K | — | $2K | 5.00% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 116 HUNTINGTON AVENUE BOSTON, MA 02116 | ESI GROUP | $448 | — | $448 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CLAIMS, CONTRACT ADMIN. | Claims processing; Contract Administrator Service code 12 | — | $792K |
| GALLAGHER BENEFIT SERVICES, INC. EIN 36-4291971 CONSULTING SERVICES | Consulting (general) Service code 16 | — | $120K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 1,246 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 25 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,271 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 1,555 | $467K |
| Vision | HIGHMARK, INC. | 2,563 | $138K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,246 | $615K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,246 | $615K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,246 | $615K |
| Stop-loss / reinsurancereinsurance | HIGHMARK CASUALTY INSURANCE COMPANY | 1,238 | $327K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,246 | $659K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,563 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.